[RunningWithScissors]

I think it should be mandatory for all floor nurses to spend half a shift down in the ER, and vice-versa; it would make interdepartmental relations SOO much better!

[Marie_LPN, RN]

Originally Posted by TazziRN

There's nothing I can add to this.......I understand that it's hard on the floors to get admits at change of shift, but floor nurses should come and watch a busy shift in the ER....maybe there would be some understanding in that direction too.

I worked with a few nurses in my brief stint as a fill-in weekend nurse for the ER, who had only worked in the ER in their nursing careers, and these nurses said things like "got it easy" "lazy" "whiners" "princesses" and "cakewalk" in reference to floor nursing and floor nurses.

Which it why i feel it would be beneficial if part of a nursing job orientation included an observation of various depts. that nurses would encounter and/or communicate with, other than the one they're working on, to give a glimpse of the other side of the fence, so to speak. It might eliminate some of the departmental stereotyping (ex. OB nurses play with babies all day, OR nursing is easy because they have one pt. at a time, and other such inaccuracies.)

[TinyNurse]

wow, it's exactly the opposite in the facility I work in..........patients are waiting 50 hours for a bed, and oftentimes get discharged directly from the ER after their admission............

[RNinED]

I have seen our ER docs clean house about the same time daily because they don't want to pass those cases on to the next DR. And yes they are usually the soft calls and those we tried to treat in ED with wahtever that didn't work. OUr next big thing will be I-STAT bedside lab testing so dispositions can be decided sooner----Hopefully

[neneRN]

Originally Posted by RNinED

I have seen our ER docs clean house about the same time daily because they don't want to pass those cases on to the next DR. And yes they are usually the soft calls and those we tried to treat in ED with wahtever that didn't work. OUr next big thing will be I-STAT bedside lab testing so dispositions can be decided sooner----Hopefully

I wouldn't hold your breath about I-Stats helping with quicker dispos, we've had them for years (Chem 8, H & H, and troponin), but its very rare that the doc stops there- they always want more labs that we can't do on an I-Stat and we end up waiting the same amount of time for all the other labs to come back. Does speed up some things though!

[RNWYO]

I can't speak for all ER's, of course, but there really is an increase in patient flow into the ER around mealtimes (4-6p) and this might account for the admits around the bewitching shift change. We actually have something in our hospital called the "no fly zone" to make the floor nurses happy. This means we cannot take patients to the floor from 645-720 to allow for shift change/report. This is usually acceptable, but when the ER is overflowing with a 2+ hour wait in the lobby, we call the house super and she overrides the "no fly zone". We get evil looks from the floor nurses as we deliver our patients, but it really isn't ED's fault. Believe me, we're running our ASSES off down here!!!

[Maverick80]

i'm a tech in a level 1 trauma center ER. I'm in nursing school and will be done in 2 1/2 semesters with my BSN. I ofen get caught in the middle of these little fights between floor nurses and the ED nurses. The floor nurses get very upset about patients right before or after shift change and i'm the one who gets to hear about it. The ED nurses don't do it on purpose and we have a policy that once the room is assigned the floor has 45 minutes to get the room cleaned and ready. That's the way it is. so when 45 minutes is up your getting the patient. We don't have room for them and once they are out of the computer we can not take them back and put them back in.

I'm not a nurse yet but i've seen ED nurses deal with some pretty crazy things, and being a tech i have been pulled in several directions to do my part when things get crazy. One day at 7am we had a GSW walk through our door and we called the trauma team and then came another GSW through our door a few minutes later ( a couple up at that hour shooting each other !) and within about a half hour later (trauma teams still going on) a full arrest came in by ambulance followed by a stemi!! Now that's a crazy shift change right there. As you can imagine that's nothing anyone wants to walk into but you do what you have to do!!

[colorado ER RN]

It depends on each ER, but in ours we have standing orders that allow nursing to draw labs when the pt arrives so even though the labs were drawn 5 hours ago that doesn;t mean that they saw the doc then, then the doc sees the pt orders any additional test he/she may want and then we wait for results. Then the admitting dr has to be called, but in the middle of all this there could have been cardiac arrest or trauma that have tied our doctor up so we wait in the ER. Then the pt is finally admitted and we finally get a bed for that pt, then right when we go to give report we get an ambulance--which could be another train wreck pt that needs labs,IV,cath etc and we get tied up again. We do usually get pt upstairs asap but until you work er you can;t appreciate it!

[ERJunkieBSNRN]

Hey There,

This is my first time posting and I would like to start off by first saying it would be beneficial for us all to spend time in different units to see the adversities within our jobs. I am an ER nurse, have only been an ER nurse but have worked at different facilities and thus have seen the complexities that ED's and nurses face. I work in a facility that has little to no support staff...that means the nurses are taking patients to every service (CT, XRAY, US) and they also run lab work to the laboratory, perform EKG's, etc. Due to the number of patients we see a large majority of our physicians will try to do a basic workup on folks in order to expedite care and turn patients over in a timely matter. So often a BMP and CBC are ordered, something unusual shows up and then additional orders are added. This tends to happen a lot. A few orders here and then add more an hour later when you get your first set of results back. You had indicated that a person was waiting downstairs for 5 hours...there could be a variety of reasons....the adding on of orders as I had stated....CT with oral contrast workups. Waiting for your admitting service. Admitting service taking the chart and showing up an hour later with orders. However, they feel a large number of orders could/should be done by us before they get the patient upstairs. This is a point of contention right now w/in our hospital. Recently I had a patient w/ a GI bleed and it was taking time to get the 4 units of PRBC's and 4 of FFP. The MOD was wanting the patient to stay in the ED so we could transfuse the patient. He was stabile enough to be able to have this done upstairs. I can tell you that w/ 90% of the patients I admit, the majority of what the admitting physicians want done are done in our dept initially. Repeat labs, meds, vitals seem to be the only thing that remains. We start the antibiotics they need, etc. Someone had mentioned that it appears as though an influx of patients come at shift change. The providers gather their charts at their convenience and do their charts/admissions, etc often at once, especially if they know they will be going home soon. While it is a challenge for your floor, it is a challenge for us as well to get orders done on the other patients, to copy charts, gather personal belongings, arranging for security to pick up belongings, getting acutely ill patients to surgery, etc. and then transporting the patient(s). When I get the patient upstairs someone takes the chart from me and I am left alone to get the patient situated in a bed. I can tell you that our department is so busy nurses are sent from other floors/departments to assist. 95% percent of them (and I don't believe this is an exaggeration) are overwhelmed and appear as though they've been thrown into a battlefield. On top of all of those toss in a trauma or an acute MI workup into the mix and see how much more that delays admissions. My two cents worth.

[sunciray]

As an emergency nurse for 18 years, I can say that the problem is a combination of many factors: indecisive emergency physicians that write orders in a piecemeal fashion because they are concerned about lawsuits, failure to either implement or enforce hospital admission policies, power plays, and unfortunately, many nurses that are burned out or lazy and do not want to get another patient...so they hold onto to the ones they have as long as possible. Additionally, there are the uncooperative attending physicians that do take some time in writing orders, or if you are in an academic facility, the numerous residents and interns that have to see the patient before they are admitted. Lastly, the on-call personnel that are found in many ancillary departments such as radiology in the smaller facilities also compound the problem. Patients must wait until the CT tech or sono tech comes in to do the test before the patient disposition can be made. It is a mess, and the solution is just not a simple one.

One thing that I strongly believe will help to alleviate the problems is the nurse to nurse relationship. I believe that floor and critical care unit nurses need to do a share day in the emergency department, and the ED nurses need to do a share day on the floors and in the units...nothing fosters more understanding of what each other must deal with than getting a first hand account.